The Quick Answer: If you or a family member gets one cavity in three years, it’s not just an unnecessary expense that will lead to future pain and expense; it’s also a wake-up call to take preventative action. Buy more fluoride? No! Eat less sugar (and more whole foods, including green salads).
Here’s a fresh look at a common childhood disease: dental cavities (or caries). The chronic diseases—type 2 diabetes, heart disease, cancer, autoimmune diseases, etc.—may take decades to develop, but cavities, which have a shared cause, can develop in baby teeth. There’s a saving grace in the baby tooth cavity—if taken seriously, it’s an early warning that preventive change is needed to save the permanent teeth that follow. Dental caries are highly preventable and curable, if caught early, by diet reform.
Dental cavity questions:
• How big a problem is dental decay? Cavities is the single most common chronic childhood disease (over 50% of children 5-9 years have at least one cavity; 78% of 17-year-olds do. (How do 22% reach 17 with none?)
• What causes cavities? Sugar, mainly. Bacteria that live in the plaque on your teeth use sugar to produce acid that can demineralize tooth enamel. The body can repair this through remineralization but only if the plaque isn’t too acidic.
• Can cavities be prevented? Technically, yes, but you must move beyond the advice of the old dental establishment and the government. If you Google “dental cavities, prevention” you will get official guidance on brushing & flossing, fluoridation, dental sealants, and regular visits to your dentists. This is all good, it’s certainly a good business and does reduce decay, but history shows it won’t prevent or cure cavities. Surprisingly, diet—the major factor—gets little mention.
• So, can people actually prevent and even cure cavities? Pretty much, but there are issues of family history, including genetics, and the fact that you’re starting well after your teeth were formed.
• Is preventing and curing cavities a recent discovery? No. Important discoveries were made way back in the 1920s and 1930s and then forgotten. So we should remember two pioneering women: Dr. May Mellanby, and Mrs. Weston Price.
Dr. May Wellanby was the wife of Dr. Edward Wellanby who solved the problem of rickets (like caries, a bone disease) and contributed to the discovery of vitamin D. His wife, a brilliant scientist in her own right, studied the epidemic of dental caries using dogs and then humans. She found diet combinations that drastically reduced cavity formation and actually healed smaller cavities. May Wellanby published her discoveries in 1924 (credit to Stephan Guyenet for this summary):
• A diet with adequate minerals, particularly calcium and phosphorous (the ratio is important), is critical;
• The diet must also include the fat-soluble vitamins, especially vitamin D which is also obtained from sunlight;
• Dr. May Wellanby recommended a varied diet of whole foods, including dairy, and cautioned against excessive sugar and [refined] grain intake.
Mrs. Weston Price didn’t leave a record of her work; her contribution was to assist her husband during the ‘30s on expeditions around the world to the most primitive indigenous people they could find. Their mission was to study the dental health of indigenous people who had not yet adopted the Western diet of refined foods, and compare them to their cousins who had moved to the city and converted to the modern diet. Weston published his findings in the 1939 book Nutrition and Physical Degeneration:
• Price found that for the same indigenous population, dental cavities were 35 times higher (that’s 3400% more) on the modern refined, sugary, diet, than on the traditional diet.
• Traditional diets were not only protective against cavities; they also resulted in well-formed dental arches in newborns. Their cousins born in the city had the crowded malformed dental arches that delight the orthodontist.
• Price visited tribal people all over the world who lived in varied climates and ate different diets. What they had in common was an evolved food tradition based on natural foods and game at hand that sustained health.
Here we have a familiar story: science has discovered a great deal about how caries develop, but we must turn to food traditions to learn how we can prevent them. When scientists studied dental plaque—the coating on your teeth—they found a surprisingly complex community of bacteria that they gave a new name: biofilm. Many of the bacteria in biofilm produce acid and when there is too much acid (the pH has to drop below 5.5) tooth enamel is demineralized, or eaten away. When the pH is above 5.5 (less acidic) enamel can be remineralized, or repaired if given a healthy diet. Your saliva is key to a healthy acid level.
The biofilm is constantly bathed in saliva. Saliva, 98% water and sometimes called the blood supply for the mouth, is a rich broth that can buffer excess acid; it contains minerals, proteins, antibacterial agents, and enzymes needed for digestion of food. The mouth produces about a liter of saliva each day, so drinking adequate water is as important as a healthy diet. Prescription drugs present a special problem; there are around 3000 medications that have the side effect of “dry mouth,” which accelerates the formation of caries and gum disease. If this warning is on the package insert of a drug you take, consult your dentist.
I had a phone interview with Dr. Cliff Sorensen, who practices preventive dentistry in Ogden, Utah. I had read about Dr. Sorensen’s work so gave him a call, thinking that because he had once dated both my future Beautiful Wife and one of my charming sisters, he would talk with me. We had a great conversation about saliva, biofilm, acid-producing bacteria, caries, and the difficulty of getting people to change self-destructive habits. Dr. Sorensen gave up drill-and-fill dentistry, at considerable personal expense, when he became convinced that, for most, dental caries was preventable and curable. As explained, he provides a cariogenic assessment and based on the outcome, provides guidance and support as appropriate. (I like that word, cariogenic, meaning cavity or carie-producing.)
Dr. Sorensen doesn’t give nutrition advice, except to eat a healthy low-sugar diet. I am not aware of any dentist who does; as you know, the subject is complex and the science incomplete. But the guidance of science, tradition, and scripture combined can give us the best possible answer and that is the goal of this blog. For example:
• Protective (non-cariogenic) dietary includes a variety of whole foods including dairy, plus adequate vitamin D (discussed here) as suggested by Dr. May Wellanby nearly 80 years ago. Calcium and phosphorous are important minerals for bone health. It's well-advertised that milk and dairy supply calcium; it's less well-known that plants are an essential source. An important plant source is the leafy green vegetables used in salads.
Comment: Share your favorite salad recipes, or your experience preventing cavities.